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Surgeons Develop Innovative Life-Saving Treatments to Correct Massive Bleeding in Trauma Patients
Date:10/9/2007

timulate coagulation.

The Vanderbilt protocol, developed by a multidisciplinary group of surgeons, anesthesiolo-gists, and transfusion medicine specialists, calls for the hospital blood bank to prepare packets of red blood cells, platelets, and fresh frozen plasma in predefined ratios and continue to replenish these every 20 to 30 minutes until a patient is stabilized. The ratios of blood components (plasma and platelets) are more closely approximate to that of blood being lost than what is considered "standard" transfusion practice at most trauma centers.

"We use a tighter ratio so we can stop the bleeding up front in an effort to limit the total blood products needed to reduce the amount of fluid necessary to control the patient's cardiovascular stability," medical student Au explained.

When trauma surgeons at Vanderbilt University Medical Center evaluated outcomes after they instituted a transfusion protocol that replaced the blood trauma patients had lost and at the same time instituted coagulation, they found that there were more unexpected survivors and fewer unexpected deaths. The survival rate was 15 percent higher in patients who received the exanguination protocol with an unexpected survivor rate of 20.3% (compared to only 5.7% for patients who did not receive the TEP). As well, the rate of unexpected deaths was 14 percent lower (2.9% versus 17.1%).

The study included 139 patients; 69 were treated under the TEP and 70 were treated before the TEP was instituted. The differences in outcome were statistically significant. Unexpected survival and unexpected death in this study were defined by the Trauma Related Injury Severity Score (TRISS) Methodology, which determines the probability of survival on the basis of the severity of injury, the patient's condition on admission to the hospital, and age.

The protocol also decreased the amount of fresh frozen plasma and platelets that were needed in the first 24 hours of treatment.
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SOURCE American College of Surgeons
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